Research reveals conflict between nursing values and healthcare reality

New research from Victoria University of Wellington explores the conflict between the values of nurses and the values that drive healthcare delivery.

Dr Helen Rook, who graduates next week from Victoria University of Wellington with a PhD in Nursing, investigated the daily challenges nurses face in meeting the needs of patients while addressing healthcare priorities and attending to their own personal and professional obligations.

Her research looks at the effect of the demands on nurses who work in acute medical settings in New Zealand. She found that healthcare environments obstruct nursing values, creating a gap between how nurses want to, and how they are able to, practice. Dr Rook says this tension causes anxiety, exhaustion, cynicism and burnout. To manage this, nurses use unconscious strategies that result in a prioritisation of functional tasks over all other care.

"Nurses go into the profession with an assumption that they will be caring for people who are sick, taking a moment to talk with them and build caring relationships," says Dr Rook. "But the culture doesn't allow for this—District Health Board (DHB) managerial imperatives of getting patients out of hospital quickly, combined with financial constraints, mean that it just isn't possible. And that is profoundly conflicting for nurses," she says.

Dr Rook spent more than 300 hours in medical wards of New Zealand's DHBs observing nursing behaviours and talking to nurses about how they want to nurse, and how they are actually nursing. Her research concluded that whilst nurses are expected to be caring and compassionate, what it means in practice is that nurses have to "get the paperwork done".

"I watched nurses walking past patients who were calling out for help, and call bells that were unanswered, not because nurses were uncaring but because they had so many other things to do, to comply with," says Dr Rook. She says nurses are challenged on a daily basis to negotiate between meeting the complex needs of patients whilst addressing healthcare priorities. "There is a growing philosophical debate about whether the healthcare climate is dehumanising health care professionals' encounters with patients, including those of nurses, and creating a culture where enacted values are inconsistent with professionalism."

Dr Rook says it is critical that any attempt to embed nursing values into clinical nursing practice is founded on a strategy that recognises and mitigates against competing organisational priorities. She says bureaucratic and management models dominate healthcare delivery and it is imperative that nurses are supported with strong nursing leaders and educators to practice effectively within this environment. In turn, organisations need to understand the values of professional nursing practice and consider how healthcare environments can enable nurses to live their values.

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